Doctors Want Out Of Indigent Births

MERRITT ISLAND — Central Brevard obstetricians have asked state and county officials to let midwives take over the delivery of babies for low-income women in the area.

Dr. Alan Tobgui and six other obstetricians say spiraling malpractice insurance costs and the increasing number of maternity patients in Brevard County prompted their request.

The doctors, who have staff privileges at Wuesthoff Memorial Hospital in Rockledge and Cape Canaveral Hospital in Cocoa Beach, had threatened to stop delivering babies for indigent mothers by Jan. 1 if the county didn't hire midwives to take over for them.

''The main issue is why are we responsible to take care of indigents,'' Tobgui said Thursday. ''It's the taxpayers' problem. This is the county's responsibility to solve it. We can help them, but it's not our problem.''

But Pete Wahl, director of Brevard Health and Social Services, said the county isn't legally bound to provide delivery services and can't afford the nearly $500,000 it would cost for a countywide program.

The issue was to have been brought to commissioners Tuesday, but was pulled from the agenda after Wahl met with Tobgui and several other doctors Thursday. Wahl said county and state health officials will meet again with the doctors Dec. 5 to iron out details. ''What we've got is an opportunity to create a model program for what is a communitywide problem,'' Wahl said. ''We all share a part of it.''

The doctors want to form a corporation to hire the midwives using county and state money. Under the plan the midwives also would provide prenatal care now available through the health department.

Private doctors have agreed they would continue to be responsible for high- risk pregnancies and problem pregnancies.

The county pays each hospital about $60,000 a year for deliveries eligible under its indigent program, said Joan Madden, assistant social services director.

Under the doctors' proposal, the county and state would divert their funds to a corporation set up by the doctors.

The county last year reimbursed the doctors and hospitals for about 20 percent of the 1,099 indigent births in Brevard County.

Another 55 percent were paid through the state's Medicaid program; the cost of another 17 percent was absorbed by doctors and the hospitals.

Prenatal care is handled by the state health department.

Both county and medical officials say the issue is workload, not cost.

Tobgui said the central Brevard doctors are handling about 40 indigent births a month at the two hospitals, almost half of their maternity patients. ''We're not asking for any financial increase,'' Tobgui said. ''We're overburdened with the work and the malpractice insurance.''

Malpractice insurance for obstetricians has skyrocketed, particularly in Florida.

Tobgui said Brevard obstetricians pay about $60,000 a year.

The high costs have prompted many doctors to bail out of obstetrics, meaning a bigger workload for those who remain.

''So to make a living we have to increase the number of private patients who can pay'' for the doctors' services, Tobgui said. The indigents get caught in the middle.

''We cannot physically take care of these patients anymore,'' he said.

Tobgui said the doctors would be willing to be on call for free should the midwives have a difficult birth and need help.

He estimated that the program could be run with three midwives at an annual cost of about $30,000.

Wahl said he doesn't know if the doctors' proposal would lead to a countywide program.